Oldervoll, L. M., Loge, J. H., Lydersen, S., Paltiel, H., Asp, M. B., Nygaard, U. V., . . . Kaasa, S. (2011). Physical exercise for cancer patients with advanced disease: a randomized controlled trial. The Oncologist, 16, 1648–1657.

To test the hypothesis that physical exercise reduces fatigue and improves physical performance in patients with advanced cancer.

Patients were randomly assigned to physical exercise (PE) or usual care (UC) groups. The PE group had two exercise sessions per week that lasted 50 to 60 minutes after a 10-minute warm-up. Exercise was performed in groups of two to eight and was supervised by a physiotherapist. Sessions included circuit training and stretching/relaxation. Focus was on muscle strength, balance, and aerobic endurance. Pre- and postintervention were performed at baseline at immediately after the intervention period.

• In total, 231 patients (62.3% female, 37.7% male) were included. 
• Mean age was 62.4 years (range 24–86). 
• Multiple types of cancer in advanced stage were included.
• Of the patients, 55% were receiving chemotherapy and 75% had a Karnofsky Performance Status score of 80 or greater.
• Of the patients, 65% had a baseline low level of activity of less than one hour per week.

• Multi-site
• Norway

• Patients were undergoing the end of life phase of care.
• The study has clinical applicability for palliative care.

This was a randomized, controlled trial.

• Fatigue questionnaire
• Physical activity prior to the study (none, <1 hour/week, 1-2 or 3 hours/week)
• Motivation (0-10 numerical scale)
• Physical performance tests: sit-to-stand, grip strength, maximal step length (balance), and shuttle walk (how far and fast one can walk) tests

Median survival times for all included patients were 11.1 months in the PE group and 12.3 months in the UC group. In the PE group, exercise adherence was 69% on average (11 of 16 sessions).  Regression analysis showed no significant between-group effect in physical fatigue (estimated mean difference = -0.3; confidence interval [-1, 1.0]; p = 0.62).  There were significant differences between groups in shuttle walk test (p = 0.008) and grip strength (p = 0.01) results. There were no apparent effects of the exercise intervention on mental or total fatigue, including mental and physical fatigue.

Findings showed that such an exercise program is feasible in patients with advanced disease and limited life expectancy. Findings did not provide support for the hypothesis that exercise reduces fatigue in this group of patients.

• The study lacked an appropriate control group.
• In the PE group, 35.5% of patients were lost to follow-up predominantly due to disease progression.

Exercise programs are feasible for patients with advanced disease. Study findings did not show that the intervention improved the symptom of fatigue, but it did improve some physical performance.